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org 2627 December 2008 | Volume 6 | Issue 12 | e320

Historical and Philosophical Perspectives
I
n February, 2008, British
environment minister Phil Woolas
sparked a major row in the United
Kingdom when he attributed the high
rate of birth defects in the Pakistani
community to the practice of marriages
between first cousins. If you have a
child with your cousin, the likelihood
is therell be a genetic problem, he
told the Sunday Times [1]. Although
a Muslim activist group demanded
that Woolas be fired, he was instead
promoted in October to the racially
sensitive post of immigration minister.
Most of his constituents would surely
have shared Woolas view that the risk
to offspring from first-cousin marriage
is unacceptably highas would many
Americans. Indeed, in the United
States, similar assumptions about the
high level of genetic risk associated
with cousin marriage are reflected in
the 31 state laws that either bar the
practice outright or permit it only
where the couple obtains genetic
counseling, is beyond reproductive age,
or if one partner is sterile. When and
why did such laws become popular,
and is the sentiment that informs them
grounded in scientific fact?
US prohibitions on cousin
marriage date to the Civil War and
its immediate aftermath. The first
ban was enacted by Kansas in 1858,
with Nevada, North Dakota, South
Dakota, Washington, New Hampshire,
Ohio, and Wyoming following suit in
the 1860s. Subsequently, the rate of
increase in the number of laws was
nearly constant until the mid-1920s;
only Kentucky (1946), Maine (1985),
and Texas (2005) have since banned
cousins from marrying. (Several
other efforts ultimately failed when
bills were either vetoed by a governor
or passed by only one house of a
legislature; e.g., in 2000, the Maryland
House of Delegates approved a ban
by a vote of 82 to 46, but the bill died
in the Senate.) The accompanying
map (Figure 1) illustrates both the
extent and the progress of legislation.
It demonstrates that western states
are disproportionately represented,
reflecting the fact that either as
territories or newly admitted states,
they were writing their marriage codes
from scratch and hence prompted to
explicitly confront the issue. For the
same reason, these states tended to be
the first to prohibit cousin marriage.
Perhaps surprisingly, these bans are
not attributable to the rise of eugenics.
Popular assumptions about hereditary
risk and an associated need to control
reproduction were widespread before
the emergence of an organized
eugenics movement around the turn
of the 20th century. Indeed, most
prominent American eugenists were, at
best, lukewarm about the laws, which
they thought both indiscriminate in
their effects and difficult to enforce
Its Ok, Were Not Cousins by Blood:
The Cousin Marriage Controversy
in Historical Perspective
Diane B. Paul, Hamish G. Spencer*
The Historical and Philosophical Perspectives series
provides professional historians and philosophers
of science with a forum to reflect on topical issues in
contemporary biology.
Series Editor: Evelyn Fox Keller, Massachusetts
Institute of Technology, United States of America
Citation: Paul DB, Spencer HG (2008) Its ok,
were not cousins by blood: The cousin marriage
controversy in historical perspective. PLoS Biol 6(12):
e320. doi:10.1371/journal.pbio.0060320
Copyright: 2008 Paul and Spencer. This is an
open-access article distributed under the terms
of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Diane B. Paul is Professor Emerita, Department of
Political Science, University of Massachusetts Boston,
Boston, Massachusetts and Research Associate,
Museum of Comparative Zoology, Harvard University,
Cambridge, Massachusetts, United States of America.
Hamish G. Spencer is Professor, Allan Wilson Centre
for Molecular Ecology and Evolution, National
Research Centre for Growth and Development,
Department of Zoology, University of Otago,
Dunedin, New Zealand.
* To whom correspondence should be addressed.
E-mail: h.spencer@otago.ac.nz
doi:10.1371/journal.pbio.0060320.g001
Figure 1. Map of the United States Showing States with Laws Forbidding First-Cousin Marriage
Different colors reflect differences in the timing of passage of the laws. Colorado is shaded because
its law was repealed. White states never had such bans.
PLoS Biology | www.plosbiology.org PLoS Biology | www.plosbiology.org 2628 December 2008 | Volume 6 | Issue 12 | e320
[2]. In the view of many eugenists,
sterilization of the unfit would be a far
more effective means of improving the
race.
Nonetheless, in both the US and
Europe, the frequency of first-cousin
marriagea practice that had often
been favored, especially by elites
sharply declined during the second half
of the 19th century [3]. (The reasons
are both complex and contested, but
likely include improved transportation
and communication, which increased
the range of marriage partners; a
decline in family size, which limited the
number of marriageable cousins; and
greater female mobility and autonomy
[4,5].) The fact that no European
country barred cousins from marrying,
while many US states did and still do,
has often been interpreted as proof of
a special American animosity toward
the practice [6]. But this explanation
ignores a number of factors, including
the ease with which a handful of
highly motivated activistsor even
one individualcan be effective in
the decentralized American system,
especially when feelings do not run
high on the other side of an issue.
The recent Texas experience, where
a state representative quietly tacked
an amendment barring first-cousin
marriage onto a child protection bill, is
a case in point.
The laws must also be viewed in
the context of a new, postCivil War
acceptance of the need for state
oversight of education, commerce, and
health and safety, including marriage
and the family. Beginning in the 1860s,
many states passed anti-miscegenation
laws, increased the statutory age of
marriage, and adopted or expanded
medical and mental-capacity
restrictions in marriage law [7]. Thus,
laws prohibiting cousin marriage were
but one aspect of a more general
trend to broaden state authority in
areas previously considered private.
And unlike the situation in Britain
and much of Europe, cousin marriage
in the US was associated not with the
aristocracy and upper middle class but
with much easier targets: immigrants
and the rural poor. In any case, by the
late nineteenth century, in Europe as
well as the US, marrying ones cousin
had come to be viewed as reckless, and
today, despite its continued popularity
in many societies and among European
elites historically, the practice is highly
stigmatized in the West (and parts of
Asiathe Peoples Republic of China,
Taiwan, and both North and South
Korea also prohibit cousin marriage)
[811]. The ironic humor of a New
Zealand beer advertisement (Figure 2)
nicely reflects current opinion in much
of the world. But is the practice as risky
as many people assume?
Until recently, good data on which
to base an answer were lacking. As a
result, great variation existed in the
medical advice and screening services
offered to consanguineous couples
[12]. In an effort at clarification, the
National Society of Genetic Counselors
(NSGC) convened a group of experts
to review existing studies on risks to
offspring and issue recommendations
for clinical practice. Their report
concluded that the risks of a first-cousin
union were generally much smaller
than assumedabout 1.7%2% above
the background risk for congenital
defects and 4.4% for pre-reproductive
mortalityand did not warrant any
special preconception testing. In
the authors view, neither the stigma
that attaches to such unions in North
America nor the laws that bar them
were scientifically well-grounded.
When dealing with worried clients, the
authors advised genetic counselors to
normalize such unions by discussing
their high frequency in some parts
of the world and providing examples
of prominent cousin couples, such as
Charles Darwin and Emma Wedgwood
[13].
In the aftermath of controversies
ignited by Woolass comments and
similar remarks in 2005 by Labour
Member of Parliament Ann Cryer, who
asserted We have to stop this tradition
of first cousin marriages [14,15], the
NSGC report was cited by numerous
scientific, legal, and lay commentators
as testament to the low risk of cousin
marriage and hence the lack of any
compelling biological reason to avoid
it. (Literally dozens of authors also
asserted that the Darwins had ten
healthy childrendespite the deaths of
three of them in infancy or childhood
and Charles Darwins own worries
that consanguinity had affected the
health and fertility of the intermarried
Darwin and Wedgwood families,
and of his and Emmas offspring in
particular [2,16].) Although the report
warned against generalizing from
(and hence by implication to) more
inbred populations, many writers,
roughly averaging the statistics for birth
defects and pre-reproductive mortality,
noted that first-cousin marriage only
increases the risk of adverse events by
about 3%. But for several reasons, any
overall calculation of risk is in fact quite
complicated.
First, even assuming that the
deleterious phenotype arises solely
from homozygosity at a single locus,
the increased risk depends on the
frequency of the allele involved; it is
not an immediate consequence of
the degree of relatedness between
cousins. (Interestingly, despite the
British biometricians harsh criticism
of Mendelism, they were the first to
describe this dependency in 1911
[17,18].) If a deleterious recessive
allele has a frequency q, the ratio of the
recessive phenotype in the offspring
of first cousins relative to a panmictic
population is (1 + 15q)/16q, which
means the increase in risk is greater
for rarer conditions [19]. For example,
if q is 0.01, the ratio is 7.2; if q is 0.001,
it is 63.4. Consequently, statistics
on the risks associated with cousin
marriage are necessarily averages across
many traits, and they are likely to be
different for different populations,
which will often vary in the frequency
of particular deleterious alleles. In
the Pakistani immigrant population,
for example, the quoted high average
rate of birth defects may mask a single
trait (or small number of traits) at
very high frequency, a situation with
different medical consequences from
one characterized by a larger number
of less-frequent disorders.
Second, children of cousin
marriages are likely to manifest an
increased frequency of birth defects
showing polygenic inheritance and
interacting with environmental
variation. But as the NSGC report
notes, calculating the increased
frequency of such quantitative traits
doi:10.1371/journal.pbio.0060320.g002
Figure 2. A Beer Advertisement from New
Zealand, Part of a Humorous Series
PLoS Biology | www.plosbiology.org PLoS Biology | www.plosbiology.org 2629 December 2008 | Volume 6 | Issue 12 | e320
is not straightforward, and properly
controlled studies are lacking.
Moreover, socio-economic and other
environmental influences will vary
among populations, which can easily
confound the effects of consanguinity.
Inbred populations, including British
Pakistanis, are often poor. The mother
may be malnourished to begin with,
and families may not seek or have
access to good prenatal care, which may
be unavailable in their native language
[20]. Hence it is difficult to separate
out genetic from socio-economic and
other environmental factors.
Third, as the report also notes, the
degree of increased risk depends on
the mean coefficient of inbreeding
for the population. That is, whether
first-cousin marriage is an occasional
or regular occurrence in the study
population matters, and it is thus
inappropriate to extrapolate findings
from largely outbred populations with
occasional first-cousin marriages to
populations with high coefficients of
inbreeding and vice-versa. Standard
calculations, such as the commonly
cited 3% additional risk, examine
a pedigree in which the ancestors
(usually grandparents) are assumed
to be unrelated. In North America,
marriages between consanguineal kin
are strongly discouraged. But such an
assumption is unwarranted in the case
of UK Pakistanis, who have emigrated
from a country where such marriage is
traditional and for whom it is estimated
that roughly 55%59% of marriages
continue to be between first cousins
[2123]. Thus, the usual risk estimates
are misleading: data from the English
West Midlands suggest that British
Pakistanis account for only ~4.1% of
births, but about 33% of the autosomal
recessive metabolic errors recorded at
birth [24]. However, for a variety of
reasons (including fear that a cousin
marriage would result in their being
blamed for any birth defects), UK
Pakistanis are less likely to use prenatal
testing and to terminate pregnancies
[20,25]. Thus the population
attributable risk of genetic diseases at
birth due to inbreeding may be skewed
by prenatal elimination of affected
fetuses in non-inbred populations.
Moreover, the consequences of
prolonged inbreeding are not always
obvious. The uniting of deleterious
recessives by inbreeding may also lead
to these alleles being purged from
the population. The frequency of
such deleterious alleles, then, may be
decreased, which (as shown above)
means the relative risk is greater, even as
the absolute risk decreases.
For all these reasons, the increased
population-level genetic risks arising
from cousin marriage can only be
estimated empirically, and those
estimates are likely to be specific to
particular populations in specific
environments. And of course for
particular couples, the risks depend
on their individual genetic makeup.
It is also worth noting that both the
increased absolute and relative risk
may be relevant to assessing the
consequences of consanguineous
marriage. If the background risk of a
particular genetic disorder were one
in a million, a ten-fold increase in
relative risk would likely be considered
negligible, because the absolute
increase is nevertheless minuscule.
Conversely, the doubling of an absolute
risk of 10% would surely be considered
unacceptable. But the doubling of
a background 3% risk may fall on a
borderline, with the increase capable of
being framed as either large or small.
In any case, different commentators
have certainly interpreted the same risk
of cousin marriage as both insignificant
and as alarmingly high.
Those who characterize it as slight
usually describe the risk in absolute
terms and compare it with other risks
of the same or greater magnitude that
are generally considered acceptable.
Thus it is often noted that women over
the age of 40 are not prevented from
childbearing, nor is anyone suggesting
they should be, despite an equivalent
risk of birth defects. Indeed, the
argument goes, we do not question
the right of people with Huntington
disease or other autosomal dominant
disorders to have children, despite a
50% risk to offspring [2629]. On the
other hand, those who portray the risk
as large tend to describe it in relative
terms. For example, geneticist Philip
Reilly commented: A 7 to 8% chance
is 50% greater than a 5% chance.
Thats a significant difference. They
also tend to compare the risk with
others that are generally considered
unacceptable. Thus a doctor asks
(rhetorically): Would anyone
knowingly take a medication that has
double the risk of causing permanent
brain damage? [30,31].
In closing, we note that laws barring
cousin marriage use coercive means
to achieve a public purpose and thus
would seem to qualify as eugenics even
by the most restrictive of definitions.
That they were a form of eugenics
would once have been taken for
granted. Thus J.B.S. Haldane argued
that discouraging or prohibiting cousin
marriage would appreciably reduce
the incidence of a number of serious
recessive conditions, and he explicitly
characterized measures to do so as
acceptable forms of eugenics [32]. But
Haldane wrote before eugenics itself
became stigmatized. Today, the term
is generally reserved for practices we
intend to disparage. That laws against
cousin marriage are generally approved
when they are thought about at all
helps explain why they are seemingly
exempt from that derogatory label.
It is obviously illogical to condemn
eugenics and at the same time favor
laws that prevent cousins from
marrying. But we do not aim to indict
these laws on the grounds that they
constitute eugenics. That would
assume what needs to be proved that
all forms of eugenics are necessarily
bad. In our view, cousin marriage laws
should be judged on their merits.
But from that standpoint as well, they
seem ill-advised. These laws reflect
once-prevailing prejudices about
immigrants and the rural poor and
oversimplified views of heredity,
and they are inconsistent with our
acceptance of reproductive behaviors
that are much riskier to offspring. They
should be repealed, not because their
intent was eugenic, but because neither
the scientific nor social assumptions
that informed them are any longer
defensible.
Acknowledgments
The authors thank Richard Lewontin,
Museum of Comparative Zoology (MCZ),
Harvard University, for hosting Hamish
Spencer during a sabbatical visit. Invaluable
assistance in researching the history of
American state statutes was provided by
Mindy Roseman of Harvards Law School
and Terri Gallego ORourke of its Langdell
Law Library. Our efforts to locate and
interpret Asian legislation were assisted
by William Alford and librarian Nongii
Zhang at the Law School, by Mikyung
Kang and Wang Le (visiting from Fudan
University) at the Yenching Library, and
Jennifer Thomson of the MCZ. We are also
deeply grateful to Ken Miller of the Zoology
Department, University of Otago, for
PLoS Biology | www.plosbiology.org PLoS Biology | www.plosbiology.org 2630 December 2008 | Volume 6 | Issue 12 | e320
drawing the map; to Honor Dillon, Assistant
Brand Manager Tui, for permission to use
the Tui ad; and to Robert Resta, Swedish
Hospital, Seattle, for providing detailed
comments on a draft of the manuscript, thus
saving us from at least some errors.
Funding. This work was supported by the
Allan Wilson Centre for Molecular Ecology
and Evolution, which funded DBPs visit to
the University of Otago.
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